State News : Texas

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  


Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.


Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.


Texas

STONE LOUGHLIN & SWANSON, LLP

  512-343-1385

Claimant Attorney Leslie Causabon Found Not Guilty

 
On October 31, 2023, a Travis County jury found attorney Leslie Casaubon not guilty of the offenses of Securing Document by Deception and Insurance Fraud. You can view the Jury Verdict here.

DWC announced Ms. Casaubon’s indictment in a News Release issued on March 26, 2021. The indictments alleged that from July 1, 2017 to August 31, 2019, Ms. Casaubon and her staff submitted billing to DWC’s attorney fee processing system for work they did not do.

In January, we reported that attorney Roger Farahmand, who was indicted along with Ms. Casaubon, had entered into a consent order with the Division which required him to testify in Ms. Casaubon’s trial.  The criminal case against Mr. Farahmand was dismissed on December 29, 2022 because “[t]he defendant has been granted immunity in light of his testimony.”  It is not known whether Mr. Farahmand was called to testify in Ms. Casaubon’s trial.    

Claimant attorney Adam Henderson was also indicted at the same time as Ms. Casaubon and Mr. Farahmand for allegedly submitting bills for work he did not do.  The case against Mr. Henderson is still pending. There is a pre-trial hearing currently set in his case for December 21, 2023.  

Intergovernmental Risk Pool Not Immune from Being Fined by DWC

 
The Texas Third Court of Appeals in Austin rejected arguments by the Texas Political Subdivisions Joint Self-Insurance Fund (TPS Fund) that DWC could not fine it for violating the Workers’ Compensation Act.  The TPS Fund describes itself as a political subdivision of the State that operates as a risk-management pool and workers’ compensation claims administrator for its members, which are public-school districts, counties, cities, and other units of local government.

DWC issued orders fining the TPS Fund a total of $132,500 for nonpayment or late payment of benefits to injured employees. The TPS Fund argued that as a political subdivision of the State, governmental immunity protects it from fines by DWC unless the legislature waives its immunity, which it says the legislature had not done for these violations, which were committed prior to a change in the law.

The gist of the TPS Fund’s argument was that prior to June 10, 2019, the legislature had not waived political subdivisions’ immunity for fines by DWC.  Effective June 10, 2019, the legislature added language to section 504.053(e) of the Act expressly waiving political subdivisions’ governmental immunity “for sanctions, administrative penalties, and other remedies authorized by Chapter 415 [the section of the Workers’ Compensation Act governing administrative violations].”

The TPS Fund argued that this newly added statute represented a change in existing law while DWC argued that the statute merely codified or clarified existing law and that there was already a waiver of governmental immunity prior to this statute.  The Austin Court of Appeals agreed with DWC citing its own prior holding in a case from 2000 holding that political subdivisions that self-insure under the Workers’ Compensation Act are subject to fines by DWC.
  
Part of the court’s rationale in that case was that “If a subdivision chooses to provide [workers’ compensation] benefits through self-insurance, then the subdivision falls under the Act’s definition of insurance carrier,’ which expressly includes ‘a governmental entity that self-insures, either individually or collectively.’”  In other words, the legislature made it clear that if a subdivision elects to self-insure, they are also subject to DWC’s regulations.  They have to take the bitter with the sweet.

You can read the Court’s decision here: TPS Fund v. TDI-DWC.
 

DWC Has a New Deputy Commissioner for Compliance and Investigations



Dan LaBruyere has been named by Commissioner Jeff Nelson as the new Deputy Commissioner for Compliance and Investigations to replace Debra Knight, who was appointed State Fire Marshal in August. Here is DWC’s current organizational chart showing its executive staff including Dan:  
 

As the Deputy Commissioner of Compliance and Investigations, Dan will be responsible for overseeing DWC’s investigation of administrative and criminal violations. Compliance and Investigations includes Audits and Investigations, Enforcement, the Fraud Unit, and the Fraud Prosecution Unit. Dan previously served as a prosecutor in Travis, Hays, and Wharton Counties. 

Dan has been licensed to practice law since 2012. He is a UT grad and obtained his law degree from Baylor University. We look forward to working with Dan and getting to know him better.

Copyright 2023, Stone Loughlin & Swanson, LLP 


Designated Doctor Fined $5k and Must Complete Professional Standards Essay


DWC investigated Designated Doctor Michael Martin Leonard, M.D. in five separate claims and found that he made an unnecessary referral for additional testing, failed to attend or reschedule a DD exam, failed to review medical records before the DD exam, failed to conduct a DD exam in a professional and courteous manner, and failed to timely submit DD and work status reports.
  
In one claim, Dr. Leonard referred the employee for a neuropsychological evaluation but acknowledged in his report that a strain was the only compensable injury. He did not refer to the evaluation in his report or explain the reason for the referral. In another claim, Dr. Leonard was found to have treated the employee in an unprofessional manner when he told her he was referring her to another provider so she could “get an A on it this time.” (We’re not sure exactly what that means either).  
 
In addition to being fined $5,000, Dr. Leonard was ordered to complete the Professional Standards essay offered by Ethics and Boundaries Assessment Services, LLC (EBAS). This prompted us to ask what is EBAS and what is a Professional Standards Essay?  

According to EBAS’s website, “EBAS partners with the regulatory community, offering an exam that assesses a licensee’s understanding of ethics and boundaries in a professional setting.”  Its motto is “protecting the public through effective ethics and boundaries assessments of regulated professionals.”  EBAS’s website also includes a sample Professional Essay about a physician engaged in a personal relationship with a patient followed by questions about the essay.  

EBAS says that its essay exam is “a tool used by regulatory boards in determining if an individual is safe to return to the professional workplace.”  Test takers are required to take the essay exam at a Prometric Testing Center, presumably to reduce the likelihood of cheating.

The essay is graded by EBAS graders.  It has a maximum score of 16 points with 12 being a passing score.  Interestingly, DWC’s order just states that Dr. Leonard has to complete the essay exam, not that he has to pass it, although that was surely intended.  

You can read DWC’s Consent Order here: Order Number 20238317.


Yet Another Compound Cream Conviction


Orthopedic surgeon Michael Taba, M.D. of McKinney, along with two pharmacy owners, was convicted by a federal jury of conspiring to defraud the federal Department of Labor of more than $145 million dollars through the submission of fraudulent claims for prescription compound creams.

Federal prosecutors presented evidence at trial that pharmacy owners Dehshid “David” Nourian and Christopher Rydberg paid Dr. Taba to write prescriptions for expensive compound creams to be filled at their pharmacies and that in less than three years, they billed the Department of Labor Office of Workers’ Compensation Programs more than $145 million for those creams.  

For years, we have reported on compound cream scams in state and federal workers’ compensation systems.  Most recently, we reported that on October 11, 2022, Ms. Khyati Undavia, owner of Memorial Compounding Pharmacy, was sentenced to 27 months in prison by U.S. District Judge Andrew Hanen. This is hopefully the last time we have to report on a compound cream conviction.

Fortunately, the compound cream scam seems to have largely gone away in the Texas workers’ compensation system since DWC changed the rule to require preauthorization for all compound drugs.

You can read the Justice Department’s press release here
 

Rest in Peace


Proceedings Resolution Officer (PRO) Shaji (Jacob) Verghese passed away on November 15, 2023 after a long battle with cancer.

In a GoFundMe campaign created by his son Rohan Verghese, Rohan describes how Jacob came from India to create a life for his family in America and that he was a man of faith who taught his family how to live happily even as he was battling cancer.  

If you are interested in making a donation to help Jacob’s family pay for their many expenses due to his long battle with cancer, you can do so here: https://gofund.me/b801bc91.

We will miss Jacob.  He was a great PRO and was always helpful.
 

Proceedings Resolution Officer (PRO) Shaji (Jacob) Verghese passed away on November 15, 2023 after a long battle with cancer.

In a GoFundMe campaign created by his son Rohan Verghese, Rohan describes how Jacob came from India to create a life for his family in America and that he was a man of faith who taught his family how to live happily even as he was battling cancer.  

If you are interested in making a donation to help Jacob’s family pay for their many expenses due to his long battle with cancer, you can do so here: https://gofund.me/b801bc91.

We will miss Jacob.  He was a great PRO and was always helpful.
 

We always knew she was special

 

A long-time friend of this firm, Machelle Davidson, a senior claim representative at Accident Fund, has been named a 2023 recipient of AF Group’s Legend Award. 

In announcing the award, AF Group explained that the award recognizes AF Group  teammates who demonstrate its People First culture through their outstanding character, leadership, and commitment to excellence. Lisa Corless, president and CEO of AF Group, said that “each of our winners is an absolute shining example of who we are as a People First, values-driven organization  . . . We’re all made better by having them as part of our team.” 
                                        
We could not have said it better. Congratulations, Machelle! 
 

Copyright 2023, Stone Loughlin & Swanson, LLP


The Court didn't fall for his argument


A worker in Austin, Texas lost his bid to carve out an exception to the exclusive remedy of the Texas Workers’ Compensation Act on the ground that, at the time of his injury, he was performing duties outside of the course and scope of his employment. 

Melvin Gonzalez worked as a car detailer and porter for Dynamic Motors, a used car dealership and service garage whose advertising catchphrase is “Don’t Panic. GO DYNAMIC!” The service manager asked him to help with repairs on the roof, and while doing so Gonzalez stepped through a skylight and fell 20 feet to the concrete floor below. 

Dynamic filed a report of injury with its workers’ compensation insurance carrier and Gonzalez accepted workers’ compensation insurance benefits. He then sued Dynamic, alleging that the company was negligent in failing to provide fall protection. 

Dynamic asserted the affirmative defense that workers’ compensation insurance benefits were Gonzalez’ exclusive remedy, and the trial court agreed. On appeal, Gonzalez argued that because roof repairs are not part of Dynamic’s business, and because he was injured while performing such repairs, he was not engaged in the usual course and scope of Dynamic’s business and was, therefore, not an “employee,” as that term is defined by the Texas Worker’s Compensation Act, at the time of the injury. The Austin court of appeals disagreed and said that the Act does not contemplate a “task-by-task” approach to the issue of whether a worker is injured in the course and scope of employment. 

You can read the decision here.

Copyright 2023, Stone Loughlin & Swanson, LLP 

Supreme confusion: Is Change Afoot for SIBs? Or not?

 

In our August newsletter, we reported optimism that the Texas Department of Insurance, Division of Workers’ Compensation may begin requiring applicants for Supplemental Income Benefits to provide material evidence of job applications they have submitted in their search for work. Two conflicting developments this month have heightened the intrigue. 

 

Our Optimism in August


The source of our optimism in August was a memo to stakeholders from General Counsel Kara Mace enclosing proposed changes to the DWC Form-052, Supplemental Income Benefits Application. The proposed revision included an FAQ page with the following guidance for applicants looking for work on their own:
 

Show you were actively looking for a job by attaching job applications or other documents showing you were looking for a job.

 

Was our optimism justified?


The first development this month buoyed our optimism – it was the Division’s filing of a legal brief in the Supreme Court of Texas in the long-running litigation over the validity of the SIBs rule. As we have reported, on behalf of our client, Accident Fund Insurance Company of America, we challenged the rule as facially invalid because, among other things, it allows the Division to award SIBs to claimants who purport to be looking for work on their own but who do not document an active work search with job applications submitted as required by the Texas Workers’ Compensation Act. A Travis County district court agreed that the rule is invalid and enjoined the Division from applying it, but the Division appealed that ruling and then the Austin court of appeals muddied the water by affirming in part and reversing in part. Accident Fund now has filed a petition for review by the Supreme Court of Texas in an attempt to obtain clarity. On October 6, the Division, represented by the Attorney General, filed a response to the petition. When describing applications for SIBs filed by workers who purport to be looking for work on their own, the Division made this representation to the court:
 

The Division requires injured workers independently looking for work to document their searches by job applications. If the worker submits an online or hard-copy written application, a copy must be provided to the Division with the worker’s SIBs application.


See page 19 of Division’s Response to Petitions for Review in Accident Fund Insurance Company of America and Texas Cotton Ginners’ Trust v. Texas Department of Insurance, Division of Workers’ Compensation, Cause No. 23-0273, which is available for review and downloading here.

This representation by the Division seems to confirm that change is afoot because the position it is taking now certainly is not the position it has taken in the past. Indeed, one of the reasons that Accident Fund challenged the validity of the SIBs rule in the first place is that the Division historically has not required SIBs recipients to provide copies of job applications they claim to have submitted to employers – instead, it has merely asked them to check boxes and fill in blanks on the Form DWC-052 (Application for Supplemental Income Benefits) describing actions they have taken.
 

Or is it situation normal?


But the second development this month has clouded the picture. On October 13, we received a decision from a contested case hearing that directly contradicts the Division’s representations to the state’s highest court. In that contested case hearing, in which the issue was entitlement to SIBs, we argued that the worker was not entitled to SIBs because she had not provided copies of job applications that she claimed she had submitted to employers. The Administrative Law Judge dismissed that argument and ordered payment of SIBs. In her decision, she wrote:

 

The insurance carrier questioned the claimant’s credibility because she did not provide any documentary evidence of the applications or emails she sent to the companies listed. The insurance carrier also contended that the claimant did not make an active effort to obtain employment. The insurance carrier’s argument was considered, but it was not persuasive.

Based on a careful review of the evidence presented, the claimant met her burden of proof to establish that she demonstrated an active effort to obtain employment. The claimant performed three work search contacts each week of the qualifying periods. Accordingly, the claimant is entitled to supplemental income benefits for the third and fourth quarters.

 

So we have to ask – have Division ALJs not gotten the memo that the Division’s position has changed? Or was the Division’s representation to the state’s highest court incorrect?

Copyright 2023, Stone Loughlin & Swanson, LLP 

Now you tell me!


If you are a regular reader of our newsletter, you know that there was a challenge pending in the 13th Court of Appeals to the old Seabolt standard for determining entitlement to Lifetime Income Benefits.  The challenge boils down to whether “total loss of use” of a body part as stated in the current LIBs statute really means “total” and whether loss of use under the current LIBs statute means loss of function as a member of the body, or loss of function in regard to employability. At the Zoom trial held in this case, the trial court judge determined that the old standard still applied and that the worker could not work using his hand, despite the video evidence that showed the worker using his hand while working for himself. Well, lo and behold, well after the fact and during the course of the carrier’s appeal to the 13th Court of Appeals, SLS received an anonymous letter in the mail.  We will leave you to wonder what the letter said, but it did mention in closing that SLS did a good job at the trial, which was a nice compliment having nothing to do with the merits of the case. Given that the trial was held by Zoom with limited participants, we wonder how the writer of the letter knew so much!

In the meantime, the 13th Court of Appeals issued a Memorandum opinion on October 12, 2023 dodging the legal issue it was asked to address, and holding that “the doctrine of vertical stare decises” required the Court to follow the precedent of the Texas Supreme Court as established law affirming the use of the Seabolt standard to new law cases.  However, the precedents the Court cited were not cases where any party directly challenged the Seabolt standard itself. The cases merely applied that standard.  No challenge was made in those cases on the basis that under the current LIBs statute employability is not relevant to the application of the statutory language of “total loss of use.” The LIBs statute contains no qualifier indicating that employability is determinative of entitlement.  The Court of Appeals case is not yet final.
 

You can read the decision here
 

Copyright 2023, Stone Loughlin & Swanson, LLP